Provider Demographics
NPI:1174705073
Name:FIRST CHOICE WELLNESS AND PHYSICAL MEDICINE
Entity type:Organization
Organization Name:FIRST CHOICE WELLNESS AND PHYSICAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:KAE
Authorized Official - Last Name:BOHNSTENGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-354-4044
Mailing Address - Street 1:340 EISENHOWER DRIVE
Mailing Address - Street 2:STE.610
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5829
Mailing Address - Country:US
Mailing Address - Phone:912-354-4004
Mailing Address - Fax:912-354-4009
Practice Address - Street 1:340 EISENHOWER DR STE 610
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-1616
Practice Address - Country:US
Practice Address - Phone:912-354-4004
Practice Address - Fax:912-354-4009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038692208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADA9914Medicare UPIN